The emergence of meaning

All health disciplines depend upon well-established and organised systems of enquiry that have proved very useful in leading to a diagnosis and helping to decide on useful avenues of investigation. We depend upon these every day. The accurate history of symptoms is commonly and correctly regarded as the most crucial part of the normal clinical encounter. We trust our systems of enquiry and we need to be skilled at them.

Is there a similar process for discovering ‘stories’? Yes and no. The stories we are looking for are grounded in feelings and meanings. These feelings and meanings are unique to each person. Knowing that our patient developed headaches when her husband retired, and that she refers to it as a time of ‘adjustment’, we can try guessing why it might have been an ‘adjustment’ for her. And because we have, as adults, considerable experience of life we might guess correctly. Given that she did develop headaches we might reasonably guess that there were some negative aspects to this adjustment.

The stories we are looking for are grounded in feelings and meanings. These feelings and meanings are unique to each person.

But the best thing is to let the feelings and meanings emerge from her. In the case of our patient, I might ask ‘what were the challenges for you both when he retired?’ or, even better, ‘You mentioned it was an adjustment—can you tell me a little more about that?’ or, after she has disclosed a bit more, ‘Out of all you have been saying, what has been the hardest bit?’ Let it emerge and let her tell it.

The point is to let the patient fill the space you have opened up with her meanings and feelings, and try to hear them accurately. What you can trust is that if you are willing and able to create such a space, and to be warmly supportive, people will start to trust and reveal their hearts and their experience. The story will emerge.